X100 – Abdomen - single view
OHIP Laboratory Code — DIAGNOSTIC RADIOLOGY · Schedule of Benefits
A diagnostic radiology service consisting of a single view x-ray of the abdomen. This service is comprised of two components: a technical component (H fee: $14.90) for performing the x-ray and a professional component (P fee: $6.40) for the physician's interpretation and report. According to the General Preamble, the technical component ('H') is claimed with suffix 'B' and the professional component ('P') with suffix 'C' (: ).
When to Use
- Use X100 for a single-view abdominal radiograph (e.g., KUB) when a multi-view study like X101 is not clinically indicated.
- Use this code for urgent abdominal imaging in the emergency department where a single scout film is sufficient for initial management.
Common Pitfalls
- Billing the technical component (suffix B) for an inpatient who is admitted to the same facility within 24 hours of the service, which violates the 24-hour rule in GP11.
- Attempting to bill X100 alongside X101 for the same patient on the same day, as the single view is considered inclusive of the multi-view study.
Billing Tips
- Always split your claim into two lines: one for the technical component (suffix B) and one for the professional interpretation (suffix C) to ensure proper processing.
- Ensure the referring physician's name and billing number are included in the claim, as a valid referral is mandatory for this diagnostic service.
Effective: April 1, 2025
D. Diagnostic Radiology
DIAGNOSTIC RADIOLOGY
Diagnostic
Diagnostic Radiology
All insured services must be documented in appropriate records to establish that: an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary (: ).
For the technical component, the physician must maintain documentation that describes the process by which the physician monitors quality assurance in accordance with professional standards (: ).
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